Wednesday, January 30, 2013

There’s
a shout from up upstairs so we hurry in that direction, struggling to avoid dragging
all the pictures off the walls with our bags. Up onto the landing, to a bedroom
at the far end. I’m amazed they’ve managed to squeeze a hospital bed in here;
there’s so little room the door can’t open fully, and all the other furniture –
the TV on its stand, the armchair, the bed table and the boxes of medical
supplies – means that Mr Cooper’s nephew Steve has struggled to find space to
put his uncle on the floor. He glances up, almost losing the phone he’s
cradling between his ear and shoulder as he presses up and down on his uncle’s
chest.

Rae
starts moving what she can to make a little more room whilst I take Steve’s
place. He stands up awkwardly and throws the phone on the bed, then sits down
next to it. He tells us he’s been with his uncle for a couple of hours, fallen
asleep and then woken by a terrible gasping kind of groan. His uncle had pitched
over to the left, and when he checked he found he wasn’t breathing and didn’t
have a pulse.

‘What
does your uncle suffer with?’

‘He’s
got cancer, really bad, all over. Some other stuff.’

The
cancer isn’t a surprise. Poor Mr Cooper looks pretty terminal. His body is so
emaciated, as soon as I start compressions I feel that sickening crack as his
ribs give way. It’s like pressing on an old wicker basket.

‘Does
your uncle have a care folder?’ asks Rae. She’s thinking the same as me.

He
fetches it from the pile of papers and boxes of inco pads by the TV. Rae opens
it – then holds it up, there, first page, the distinctively red bordered DNAR
sheet.

‘Signed,
looks current,’ she says.

I stop compressions.

‘That
sheet means your uncle doesn’t want anyone to resuscitate him,’ I say, kneeling
back on my heels and rubbing my nose with the back of my hand. ‘Sorry, Steve.
We have to go by that. You did really well, though.’

‘What?’

‘DNAR. Do
Not Attempt Resuscitation. Your uncle’s had a conversation with the doctors and
the family and decided if his heart stopped he didn’t want anyone to get it going
again. But you weren’t to know, so don’t worry.’

‘No-one
said.’

‘That’s
okay. Look – why don’t you go and get yourself a cup of tea or something whilst
we make him comfortable? We’ll put your uncle back to bed and take care of
everything here, then we’ll come downstairs, have a chat and do the paperwork.
Okay?’

‘Do you
want a cup of tea?’

‘That’d
be great, Steve. Thanks. White, none.’

He
stands up, hesitates for a moment, then steps over his uncle to leave the room.

‘White,
none?’

‘Yep.’

Rae
nods.

‘I’ll do
a ring around,’ he says, more to himself than us. He goes downstairs.

***

Mr
Cooper’s family all seem to live locally. In the time it takes us to settle him
back in bed and put the room to rights, half a dozen sons, daughters-in-law,
brothers and so on are gathered in the front room, hugging each other, crying,
pacing around, taking it in turns to make the walk upstairs.

Despite
all this, Steve has still remembered our tea.

‘You’re
a good boy,’ says a tired looking woman, sitting at a pine table at the far end
of the room, an old Border Terrier on her lap.

‘Can I
sit down here with you?’

She
smiles and pushes a chair out with her slippered foot. The dog fixes me with a
stare.

‘I’m his
wife, Jean,’ she says. She ruffles the dog’s ears. ‘And this is Jinx.’

‘I’m
sorry for your loss.’

She sighs
and then presses the side of her face to Jinx’ snout.

‘We knew
he didn’t have long, didn’t we? I suppose we were ready for it. Well – I say ready. I don’t feel all that ready, now it’s happened. It’s a relief for Stan,
though. These last few weeks haven’t been all that easy for him. We did what we
could, but he knew his time was up. He wanted to be off.’

The dog licks
its chops and stares at me. He looks so grizzled and wise, it’s like he’s
waiting for me to say something so he can add something weighty of his own.

I take a
sip of tea.

Rae comes
back in from the truck and sits with us.

‘I’d
only gone out to take Jinxie for his walk,’ says Jean, leaning back in the
chair and squeezing Jinx like a wiry pillow. ‘Typical, in’t it? D’you think he
minded I weren’t there?’

‘I don’t
think so. From what Steve was saying it sounds like he died in his sleep. I
think that’s a pretty good way to go. And I think you know when you’re
surrounded by the people you love, even if they’re not actually there with you.’

She
kisses Jinx on the head and looks out on the room, which is so crowded now they’ve
had to open the patio doors. All the men in this family seem to be giants; one
more and the floor is bound to give way.

‘I don’t
know,’ says Jean. ‘I suppose the next thing is how to feed this lot.’

Tuesday, January 29, 2013

The A&E
entrance has been changed.The good news is
that the foyer is much bigger than it used to be; the bad news is we’ve lost a side room, one of the most useful rooms in the building.

Side Room One was
the Crazy Cubicle, the Isolation Suite, the room we’d discreetly hurry in to
with the disruptive patients – the psychotics, the wild drug casualties, the
hostile drunks, the acute onset dementias. It was accessible immediately you
came in. You could go straight through, shut the doors and effectively insulate
the rest of A&E from the shouting and swearing and the distress of
witnessing the level of restraint that’s needed sometimes.

But now Side Room
One has gone, and instead we have an open plan foyer.

‘Can everyone
just move down as far as possible?’ says Ellis, the charge nurse. ‘A bit more.
That’s good. It’s just we need to make as much room as we can for something
coming in. Guys – if you could put the mattress down there for me, that’d be
great.’

Two porters drag
over a double mattress and lie it on the floor in the space we’ve made. They
grin knowingly, then walk away.

‘Oh - some kid kicking
off on something or other. Apparently he’s quite a handful. Are you guys all
right there? Good.’

He looks across at
Enid, our patient, an elderly woman comfortably blanketed on the ambulance
trolley, clutching on her lap a paisley print carpet bag and a green plastic
carrier full of drugs. She nods and smiles and gives him a queenly wave.

‘We’ll get you a
space as soon as we can,’ he says, then hurries away.

The following
minutes drag with expectation. We try to chat about this and that, but it’s
noticeable that everyone’s attention is really on the automatic doors. We hear
another ambulance backing into the parking lot, but when the crew come through
they’re pushing a middle-aged guy hunched over a vomit bowl in a wheelchair,.
The crew stop short when they see the mattress on the floor.

‘Times really are hard,’ says one.

‘There’s a mad
druggie coming in,’ someone tells him.

‘Oo-oh’

They tuck
themselves as far away from the mattress as they can, even braving the space by
the pathology tube that everyone’s scared of, because it whisks specimens up a vacuum
run and then spits empties out onto the floor like the shell casings from a
howitzer.

Time passes.

‘Shouldn’t be too
much longer,’ I tell Enid. I meant the handover, but no sooner as I’ve said it
then there’s the sound of more vehicles outside, shouting, doors banging, a
confusion of instructions, the scuffles and commands of a big team effort –
then the automatic doors swish aside and four policemen stagger in carrying a
person whose arms are handcuffed behind their back and their feet zippered up
with flex.

‘Here we go!’

‘Easy now!’

‘Almost there,
fella.’

But their package
– a hefty kid in his late teens – writhes and thrashes between them like some
monstrous landed cod. A hang of drool trails beneath him as he bellows.

‘Is that mattress
for us?’ says one of the policemen.

‘Oh yes.’

‘Jolly good.’

They land the
beast, and then kneel around him puffing and sweating, hands on their catch to
keep him in place.

‘If you calm down,
we can loosen these restraints, Eddie.’

Ellis comes over
with Mark, an A&E Consultant whose simple and open expression would make him
the casting director’s choice either for the spiritual head of a monastery or a
hit man.

Suddenly Eddie seems
to relax completely. He mumbles something, but it’s hard to hear because his
great mop of curly hair is sticking to his face.

‘Let’s try and sit
you up and talk to you properly,’ says Mark. ‘Is that all right, guys? Can we
sit him up?’

The police
officers adjust their position, and cautiously set him into a sideways kind of
sit. Mark clears the hair from Eddie’s face and smiles at him.

‘I love you,’ Eddie
says.

‘That’s nice,’
says Mark. ‘That’s what I like to hear. Now then, Eddie. Tell us what’s
happened to you tonight.’

But the sudden
calm is broken by another bout of wrestling and shrieking. Mark’s expression
doesn’t change, but he shuffles backwards a little as the police officers move
in to take a stronger hold. This is the pattern Eddie falls into for the next half
an hour: periods of calm, periods of mania.

During a lull Mark
manages to check his pulse.

‘We need to give
you something to calm everything down,’ he says, releasing Eddie’s wrist. ‘Here.
Will you take this tablet for me and a little sip of water? Okay? Eddie?’

Eddie looks up.

‘I love you,’ he
says.

‘I love you too,
Eddie. Now, how about taking this pill? It’ll really help make you feel better.’

What follows is a
nightmarish stream of unconnected thoughts.

‘Do we have any
idea what he’s taken?’ says Mark after a while, lowering his hand.

‘There was
definitely some mephedrone floating around. Meow Meow or Hello Kitty, or whatever you want to call it. Plus some
LSD – quite retro, but there you go. Who knows? I don’t suppose he’s the last
casualty we’ll see from that particular party tonight. The seeds of it are
blowing all over town as we speak.’

Eddie slowly
lifts his head again and smiles at Mark.

‘You’re all so beautiful,’
he says.

‘So are you,’
says Mark. ‘Now – how about taking this pill for me?’

‘I’ll take it if
he won’t,’ says one of the police officers.

I’ve been trying
to shield Enid from all this, but actually she seems to be enjoying the
spectacle.

‘Poor boy,’ she
says with a delicious shrug of her shoulders. ‘Trussed up like a chicken. Is
that what happens when you take drugs?’

‘Sometimes.
Depends what drugs. And then you can’t always trust your dealer, so you never
really know what you’re getting. I imagine.’

She clutches her
medication bag more tightly to her.

‘I’ve got plenty
of my own without taking any more,’ she says. Especially if that’s what happens.’

‘Yes, good
advice. But I’ve always been one for watching my back, now. Isn’t that right,
George? Are you still wit’ us? I say I’ve got to watch me back, specially round
here.’

George tries to
look up but he’s just too squashed up.

‘Don’t listen to
him,’ he says. ‘He’ll bend your ear all day if you let him.’

‘Let’s have a
look at you,’ I say.

I pull the quilt
aside and check him over. Luckily it was an easy slide out of bed and he hasn’t
hurt himself. I’m able to shove the bed over, get a hand to him and with a judicious
balancing of my weight, get him up. Once he’s safely on the edge of the bed, I
go to open the curtains and let in some light. Unfortunately the rail comes
away in my hand.

‘Oops.’

‘Don’t look,
George. He’s breaking the place up, now,’ says Aidan. ‘Jayzus, but these
paramedics are a fiery bunch.’

‘Don’t worry,’ I
say. ‘I’ll fix that in a minute. Now then, how’re you feeling, George?’

‘All right,’ he
says. ‘I could use a cup of tea.’

‘I’ll see to’t,’
says Aidan. ‘I know just how he likes it.’ He pivots smartly on his walking
stick and heads for the little galley kitchen, calling back over his shoulder. ‘Would
you like one for yourself, fella?’

‘Okay. No sugar.’

Whilst Aidan
sorts out the drinks, I help George through to the lounge and sit him in his
favourite chair. He’s feeling cold, so I drape a blanket round his shoulders.
When Aidan comes in with the first cup of tea, I say: ‘Here he is – King George.’

‘King Kong, more
like’ says Aidan, putting the mug down. ‘I don’t know. What you won’t do for a
bit of attention.’

***

‘Is that you in
the photo, then, George?’

‘Yep. That’s me.
Eighteen years old in the Royal Navy.’

Aidan leans in.

‘George was in
the Navy, I was in the Merchant Marine. Guess who worked the hardest.’

George dunks his
biscuit, only just managing to get it to his mouth before it falls apart. He chomps
the biscuit down, then follows it with a sip of tea. Aidan watches him
carefully, his silvery, chin-strap beard and small bright eyes giving him the
look of some giant species of owl.

‘I sank two
minesweepers,’ George says, putting down his mug.

‘Is that so?’
says Aidan. ‘And what did you sink ‘em with? Your ego?’

Aidan has a
blurry tattoo on the back of his right hand.

‘Can I have a
look?’ I ask him.

‘Be my guest.’

He holds it out.

It’s hard to see,
but it appears to be the picture of a bare-chested woman in a WREN’s hat, surrounded
by a garland of fruit.

‘Singapore,’ he
says, then leans across with his other hand and taps George on the side of the leg
with his stick.

It snowed so
heavily last night even the washing line has a covering; it sags across the
garden in a delicately-bladed curve of ice. Every detail has been re-modelled
by the blizzard, every feature fattened and made strange, from the stone bird
bath in the middle of it all to the tangle of vegetation through the empty frames
of the tumble-down greenhouse. Track lines of animals and birds criss-cross in
the snow, this one clearly a cat; that one strangely melted and then re-frozen,
so you’d think some kind of bear had been out foraging.

Mrs Leppard has
slid out of her chair. The carer found her and called us to get her up. And
even though she says she’s frightened of going back to hospital, really we have
no choice, because none of the arrangements that should have been in place before
her discharge – the commode, the rails, the bed with sides, the hoist – nothing
has been done. Maybe the snow has slowed these things up. Even the heating is
ineffective.

The carer hands
me a folder.

‘They discharged
her yesterday after an admission for decreased mobility. She was offered a stay
at an intermediate care facility but Mrs Leppard turned it down because she was
scared it meant she was being put in a home.’

‘I’m not going in
no home!’ says Mrs Leppard. She grips the sides of her chair as if she’s getting
ready to jump up and sprint away. But her sprinting days are long gone. The
only real animation about her now is in an exaggerated facial expression of
anxiety, her chin bobbing up and down as if her jaw muscles had been replaced
with elastic bands.

The carer kneels
down and drapes a young hand over Mrs Leppard’s liver-spotted claw.

‘I think you’ve
taken it the wrong way, Sheila. I think they meant they didn’t want to see you
back in hospital because that would mean you were sick, and they want you to be
well.’

‘They’ll be so cross
if I go back.’

‘No they won’t.
Honestly they won’t.’

We set up our
carry-chair, lift her across and swaddle her in blankets. ‘It’s cold, Mrs Leppard,’
which is true, of course, but we’re also mindful of the treacherous route out
to the ambulance. We don’t want Mrs Leppard tipping us over with a panicked
grab.

***

We settle her
onto the ambulance trolley and stow the chair.

‘They’ll be
angry,’ she says.

‘No they won’t,
Mrs Leppard. Everyone just wants you to be safe and well.’

‘I’m such a
coward. Not like my husband. He was too good for this world. He died twenty
years ago. Twenty years! He was sick though. He had problems. With his heart.’

‘Oh yes? What
kind of problems?’

‘You know.
Whasisname.’

Her jaw bobs up
and down as she casts her rheumy eyes about the ambulance interior.

Rae slams the
door shut. A shouted goodbye to the carer, then the slushy trudge of her boots
as she goes round to the cab. She calls the leaving time through. I write it
down. We start to move.

‘They’ll be angry
with me. They said they didn’t want to see me back there again.’

‘Try not to worry
yourself, Mrs Leppard. Everything’s absolutely fine. The doctors will check you
over, and then if everything’s okay – as I’m sure it is – maybe you’ll still be
able to stay in that intermediate care place for a little while – not long, but
just so you can properly get back on your feet. And then whilst you’re in there,
the team can make your house ready with all the equipment you need.’

Her mouth springs
open again and she struggles to sit herself up on the trolley.

‘I don’t want
no-one in my house!’ she shrieks. ‘They’re not to go in without my say-so. I’ve
told my solicitor. He knows all about it. He’ll stop them. I won’t have it. I
won’t have it. There’s all my things there. My private things. I won’t have
them going in there.’

‘Try not to worry
about it, Mrs Leppard.’

‘No-one’s allowed
in without my say-so.’

‘Okay, Mrs
Leppard. Okay. I’m sure you can talk to the doctors at the hospital about it.
They’ll be able to put things right. No-one’s going to do anything you don’t
want to do. Okay? Everyone’s just trying to help.’

Wednesday, January 16, 2013

‘Come in, come in
befah you freet to det,’ she says, then throws the door wide and shuffles back.
Generously packed into slacks and slippers, one bra strap halfway down her arm,
she waves a cloth in front of her like she’s cleansing the air of nuisance.

‘Ya nah, Papa Jones
he fell in the bat room but I can nat git him up by myself,’ she says cheerfully,
leading us through the close and creaking old cottage to the extension out
back. ‘I do nat think he has hart himself.’

We can see the
figure of Mr Jones sitting on the bathroom floor, his trousers around his
ankles, his catheter bag off to one side. ‘Amb’lance come, Papa Jones,’ she
calls ahead, and goes to sit on the toilet facing him whilst we check him over,
her massive legs planted wide apart. ‘I will pull up your trousers when you upright
again,’ she says.

Marla’s right; it
doesn’t look as if he’s done any damage. Dementia is obviously one of his
problems, but we need to know more. Michael, the new paramedic I’m working with
tonight, asks her questions about Mr Jones’ past medical history.

‘Wait just a
minute and I will get the foldah,’ she says. She stops to stroke Mr Jones’ face
gently as she rolls past us all into the living room. ‘You be good for me,
nah,’ she says.

I fetch a chair
in so Mr Jones can rest for a moment before we move him through to the lounge.
Michael takes some observations whilst I start in on the form.

The phone rings.

Marla picks it
up.

Yes? Yes. He fell in the bathroom but he has not hart
himself. The paramedics are with him now and they will tell you more, but Papa Jones
is fine. Ye-es. Okay then. Bye then.

She hands the
phone down to Michael.

‘Who is it?’ he
asks.

‘It is the
doctor,’ she says. ‘She wan talk wit you.’

‘Oh hi doctor,’
says Michael, taking the phone, making a gesture for me to pass him the
clipboard. ‘Well it would appear Mr Jones has had a mechanical, non-injury
fall. We’ve checked him over and there’s nothing remarkable about any of his
observations ... (he lists them all).
Weight bearing, no new pain, GCS fourteen but of course that’s quite normal for
this patient. We’re just about to settle him in his chair, then all things
being equal we’ll finish the paperwork and go. Okay?’

He looks at me as
he listens to the reply, raising his eyebrows slightly.

‘That’s a good
service,’ says Michael taking one side of Mr Jones whilst I take the other. ‘The
doctor says she’ll be round in half an hour. I’m not sure why, but there you
go.’ He thinks about it. ‘I mean - why would you?’ he says.

We shuffle through together. Marla has been
busy making Mr Jones’ chair ready.

‘Can I get you
all something to drink, boys?’ she says. ‘Tea, coffee. A nice cup of Bavril.’

‘Yes!’ says
Michael. ‘Bovril would be great. I can’t remember when I last had Bovril.’ He
thinks about it. ‘Scouts,’ he says.

We settle Mr
Jones into his chair, then sit either side of him, Michael finishing the
paperwork, me glancing round the room. An ancient black and white photo of a
little boy in a tin pedal-car; a wedding photo; fine pencil drawings of various
houses; a collection of family pictures in a procession of fading colours and
fashions from the sixties onwards. An upright piano. Death in Paradise playing mute on the TV.

Mr Jones has one
leg draped over the other. He kicks it up and down gently, humming under his
breath. Dum de dum dum de dum he
sings. Then sighs and says Oh
well.

Marla comes back
into the room with a tray and passes us our drinks.

‘Thanks,’ says
Michael. ‘You know, I still can’t get over the doctor. That’s what you might
call the personal touch. Who called her, anyway?’

‘Doctor? What
doctor?’ says Marla.

‘The doctor. On the
phone. It must have been Lifeline. But then she says she’s coming round in half
an hour. At this time of night.’ He sips his Bovril. ‘You’ve got to admit, that’s
good service,’ he says.

Monday, January 14, 2013

It’s only been a
month since I was last here, and I’m surprised to see Avocet Court under wraps.
In fact, everything – Plover, Curlew and Sandpiper, the four cutely named
concrete blocks of this estate, along with the shuttered newsagent and community
centre in the hard-bitten little precinct between them - everything has disappeared behind a vast
network of metal poles, wooden walkways, yellow bucket rubble chutes and ragged,
blue nylon mesh.

Peter is waiting
for us at the end of the ramp that leads to Avocet.

‘I’m afraid it’s
not pretty,’ he says.

‘Who’ve we come
to see?’

‘My mum. She fell
sometime last night and she’s been on the floor ever since. There’s blood and shit
everywhere. I’m embarrassed, to tell you the truth.’

‘Don’t be
embarrassed. That’s what we get paid for, to deal with things like this.’

‘Yeah, but still.
It’s pretty bad.’

‘Tell us what
happened.’

He walks ahead of
us to the lift. The door slides open, and we step into a chill metal box, a single,
reinforced light in the ceiling and a burnished metal mirror at the back.

‘We only got back
from holiday yesterday. I was straight on the phone to let mum know, but she didn’t
answer. I didn’t think much of it to begin with ‘cos she often goes out shopping.
But I knew something must be up when she still wasn’t answering by lunch, so we
came round. The chain was on the door and I had to kick it in. Lucky I used to
be in the SAS.’

He smiles at me.
I can’t figure out if he means it or not. It could be true, looking at him.

‘She’s lying on
the hall floor. We haven’t moved her. We called you as soon as we were in, so
we haven’t had time to clean her up. Sorry.’

‘What’s your mum’s
name?’

‘Annie.’

‘Does Annie have
any medical problems?’

‘She had a stroke
a few years back. Apart from that, nothing, really. Her hip. And depression.
She’s been threatening to kill herself for years. Ever since I was a kid.’

He smiles at me
again, just as the lift door slides back and we step out onto the eighth floor.
Number forty stands open, the door frame splintered at the lock.

Inside, it’s
difficult to know where to put the bags. There’s a noxiously sweet, faecal drag
to the air that the energy-saving bulb in its inverted cone overhead only seems
to accentuate. Beneath its dreary light, the carpet is a chaotic pattern of splashed
browns and reds, dried pools of matter. There is a wide smear of blood along
the nearest wall where Annie must have fallen and then dragged herself back
along the hallway. She has come to rest half in and half out of what looks like
the bedroom door. A middle-aged woman is kneeling beside her now, cradling her
head. She looks up at us as we pick our way further into the hallway.

‘Mind where you
tread,’ she says. She looks back down at Annie, and picks a few bloody strands
of hair clear of her face. ‘It’s hard to believe,’ she says, to herself more
than anyone else. ‘This time yesterday I was sipping a cocktail by the pool.’

Wednesday, January 09, 2013

Meg lies sprawled
on the floor against the chair where she fell, the trolley overturned in front
of her, the contents of its plastic tray scattered around her across the
carpet: pills, inhalers, a TV guide, remote control, an empty glass tumbler,
coins, toffees and a couple of sparkling ear rings.

‘Help me up,’ she
says, waggling her hand in the air. ‘I’ve been here half an hour.’

We give her the
quick once over, then get her back on her feet. She grabs at us when we
encourage her to find her balance, pinching the backs of our arms.

‘I’m falling!’

‘We’ve got you,
Meg. You’re perfectly safe. Just take a moment to get your balance. Come on.
Where do you want to sit?’

But I hardly need
ask, judging by the well-worn cushions in the armchair by the fire, everything
arranged to hand.

‘Just a minute..’

She moves her
swollen legs stiffly, from the hip, strangely up on her toes, like an astronaut
in a spacesuit.

‘Just a minute,
now.’

She lets out a
sigh as we lower her into the chair, and puts her hands out right and left to stroke
the armrests.

‘Thank you, thank
you, thank you,’ she says, tearfully. ‘I thought I was down for good. I thought
I was going to die.’

‘Do you want a
cup of tea or something?’

‘No thank you.
But make one for yourself, if you like. Go on. I don’t mind. I’m sorry I had to
call you out.’

‘Let’s do all
your bits and pieces, Meg. Your blood pressure and the rest. Do you think you might
want to go to hospital?’

‘Hospital? I’m
allergic to hospitals.’

‘Me too. God
knows why I’m in this job.’

Rae goes into the
kitchen to find the care folder; I kneel down next to Meg’s chair and get the
obs kit out.

Hello? Meg? Are you all right?

The door opens
and a gigantic man clumps in. With his stump teeth, spade hands and big bass
voice, he could play the ogre in a pantomime with very little need for make-up.

‘Hello!’ I say,
weakly.

I saw the ambulance he
booms. I thought to myself – now I bet
that’s Meg. Are you okay, poppet?

He reaches down
to pat her on the shoulder; it’s like watching the boom of some massive crane
swing into action. Meg drapes a hand over his, and presses her cheek to it.

‘Donald,’ she
says. ‘I just want to die.’

Nonsense. Don’t talk like that, Meg. You’ll go when
the good Lord’s ready and not a moment sooner.

‘But I am ready, Donald. I’m ninety-four. I’ve
had my time. I just want to go to sleep and never wake up.’

Come on, Meg. That’s not like you.

He swivels his
bucket head to look at me.

Is she okay? Has she broken anything?

‘Nope. I think
she got away with it this time.’

Rae comes in from
the kitchen and almost drops the folder.

‘Oh. Hello,’ she
says.

I think you guys – and girl, h’ur! – I think you do a
wonderful job.

‘Thank you.’

Donald bends down
and starts clearing up the mess.

‘He’s so good to
me,’ says Meg, holding out her arm so I can unwrap the blood pressure cuff. ‘If
it wasn’t for Donald and Flora I wouldn’t be here now.’

‘Who’s Flora?’

Flora’s great, says
Donald, scooping the entire contents of the trolley into one massive palm and
transferring it carefully to the table. Flora’s
her niece. Comes round once a week, even though she’s quite a way away. Not
like the others. You never see them from one day to the next. But no doubt they’ll
come out of the woodwork in due course. Shout if you need anything.

He sits himself
down on a low chair by the sitting room cabinet, and begins flicking through an
old copy of Treasure Island.

The phone rings.
I pass it to Meg. She starts crying when she tells the person on the other end
what happened. Donald catches my eye. Flora
he mouths, then raises his eyebrows and goes back to his book.

Meg is too upset
to say much more; she hands me the phone.

‘Is that the
paramedic?’ says Flora.

‘Yep. Don’t worry
about Meg. She’s had a bit of a tumble but everything’s okay. It’s a bit of a
shock to the system, that’s all.’

‘Is that damned caretaker
with her?’

I glance across
at Donald. He looks up and gives me a cavernous, stump-toothed smile. Flora is
speaking quite loudly on the phone and I wonder if he can hear me. I press the
phone more tightly to my ear.

‘Ye-es.’

‘I’m not
surprised,’ she says. ‘He’s always round. Does she smell of drink?’

‘No.’

‘Because that’s
what he does. He goes round there and encourages her to drink. That’s why she’s
fallen over in the past. Look – I’m coming up the day after tomorrow. I’ve got
a meeting with social services because I’m not happy with the way things are
going. But you think she’ll be okay tonight?’

‘I think so, yes.’

‘Okay. Thank you.’

I hand the phone back
to Meg, who presses it to her face like it’s a gadget for soaking up tears.

Donald stands up,
ducking his head at the last minute so it doesn’t extend through the ceiling.

What did she say? Is she coming?

‘Yep. The day
after tomorrow.’

That’s grand. I knew she would. Now there’s a woman
who knows her mind.

He winks at me, closes
the book, caresses it absent-mindedly, then places it back on the sideboard
where he found it.

Monday, January 07, 2013

We’ve come out to
the neat sprawl of houses and shops just east of the city. As a money-saving
initiative, the council have switched off the residential street lamps – great
for star-gazing, but not so great for finding your way about. Still, Rae has
parked immediately outside Celia’s little bungalow and left her hazards on, so
we know where to go. Making it to the front door is more problematic. We have
to use our torches to pick our way along a crumbling concrete strip that the wilderness
of the front garden is gradually claiming for itself.

Celia comes to
the door. A wizened old lady of ninety-three, she has the rolling gait, wild
hair and benign but slightly disappointed expression of an ancient orang-utan.

‘Oh! There’s more
of you, is there?’ she says, and then slowly turns to go back inside. Rae is
just behind her.

‘Hi guys. This is
Celia. Celia called the ambulance tonight because her father had a stroke and
wandered off down the road.’

‘Her father?’

Rae widens her
eyes and nods.

‘Isn’t that
right, Celia?’

‘I don’t know. If
you say so.’

‘Where do you
think your father may have gone?’

We follow her
into the kitchen, where she slowly takes a seat back at the table and puts both
hands flat on the surface.

‘Over there. You
know. Where those girls live. My sisters. The – um – where he sleeps sometimes.’

Rae sits next to
her, tells me she found a number for the care agency, who said that Celia does
have some short term memory loss, but nothing on this scale. Frankly, they’re concerned.
They also mentioned a neighbour who pops round, but Rae says there was no
answer when she knocked.

‘I was just about
to do a round of obs when you turned up. It is looking like some kind of acute
episode, and there’s the safety issue here, so I’m thinking we might have to go
in.’

‘What are you
saying?’

‘I’m saying we’re
all just a bit worried about you, Celia. You don’t seem yourself tonight.’

‘Don’t seem
myself? Who do I seem like, then?’

‘A bit confused.’

Celia bats her
hand, tuts and crosses her legs. She is wearing odd slippers.

‘Doesn’t everyone
get a bit confused sometimes?’

‘Yes. But...’

Celia looks away,
then reaches out and strokes the door of the kitchen cabinet nearest to her.

‘I went all over
London looking for that. You can’t get it anywhere else. But that’s how I am –
particular about things.’

Next to her on
the counter is a pile of old cutlery, stacked precariously, forks on top of
knives on top of spoons.

‘When you’re gone
I think I’ll get up and give the ceiling a wipe,’ she says. ‘I like to keep
busy.’

We check the
house to make absolutely sure there’s no-one else there. Many of the rooms are
closed up, an abandoned air to them, a bed made-up but untouched, a dusty
scattering of photos on a windowsill.

‘He’s a funny
chap, my father,’ she says. ‘Very small. Runs a pub in Bethnal Green. You know
where the canal is?’ She makes a vague gesture with her hands. ‘Where it goes –
straight up? That’s where it is. My grandma had it first, then he took it on.’

She pauses, picks
some invisible lint from her trousers, then settles her ancient hands gently in
her lap.

Sunday, January 06, 2013

The night has
come down quick and glassy, hard-edged with the lights in the shop windows, a huddled,
hectic quality to everything, the restless herds of SALE shoppers and finishing
office workers migrating east, west, north and south along the main
thoroughfares, buses stacked full of people, their windows steamed, taxis and
cars beeping and jostling for position. The store we’ve been called to is so
centrally located it’s difficult to find a clear space to park. Luckily, one of
the buses is just moving off leaving just enough room for Rae to squeeze the
ambulance in. One of the store managers is waiting outside to greet us,
shivering a little in his starched white shirt. He waits as we grab what bags
we need out of the truck, and then hurries inside with us behind him.

‘It’s a
twenty-eight-year-old man,’ he says, holding the door. ‘He came to the pharmacy
with a scrip for inhalers of one kind or another, but when he was waiting in
the queue he started complaining of chest pain. He’s with my colleagues in our
little consulting room. This way.’

He eases us through
the crowded store. As always it’s a shock for the shoppers to see us there.
They double take as we struggle past with all our bags. Sometimes we have to
ask twice to get round; I can only suppose we’re so crashingly out of place it effectively
makes us invisible.

Michael is
sitting on a chair in the tiny consulting booth, bent in half with both hands
crossed flat across his breast, rocking backwards and forwards making a noise
that’s a cross between a grunt and a growl. He’s such a skinny guy, my first
thought is that he might have had a spontaneous pneumothorax. Checking his chest with my steth is difficult
because he’s making so much noise, but it sounds as if there’s equal air entry.
I hesitate for a moment, but his SATS are fine – and then, to reassure me even
further, someone opens the door to pass a message to the manager, and Michael
suddenly straightens up and looks directly at them.

‘Who’s that?’ he
says, clearly and flatly. ‘What the fuck do they want?’

There’s an
uncomplicated directness to the way he says this – and certainly not the way
you’d expect someone to speak who was struggling to breathe.

The person delivers
their message and with one last, appalled glance at Michael, withdraws in a
hurry.

‘Come on,
Michael. Sit up for us. It’ll help with your breathing. And you’ve got to slow
it right down. Easy, easy. Like this, look. In through the nose, out through
the mouth – blow it out nice and slow. In, two, three – hold and out, two,
three...’

Eventually he
sits back and stares at me with a skinned expression, like a feral creature
trapped in a cage.

‘What’s the
matter with me? They said I was having a heart attack. They did this. They
wound me up.’

Michael’s partner
Julie is in the room with us. A short, dark woman whose blunt expression is only
emphasised by the metallic blue of her eyeshadow, she shifts restlessly and
picks at her teeth with her scarlet nails.

‘He’s had a lot
of stress lately,’ she says. ‘Before he ran over here he was getting himself
proper worked up. He came out of the bedroom and just dismantled himself.’

‘Dismantled himself?’

‘Yeah, you know.
Dismantled.’

‘Shut up!’ says
Michael, shivering a little and jiggling his knees up and down. ‘I’m dying here
and what are you talking about?’

‘Have you had any
drugs tonight, Michael?’ I ask him.

‘I sniffed some
stuff, yeah.’

He bobs his head
down again and I can’t quite hear what he says.

‘Sorry? Was that
heroin, did you say?’

He looks up again
and sneers.

‘Fuck off!
Heroin? Who sniffs heroin?’

‘I don’t know. I
thought..’

‘Cocaine, mate. I did some cocaine. But so what? I do it all the
time. That’s nothing new. I lived in Barbados for years. That’s some proper mad
shit there, man. You should try it.’

He laughs, like
he’s wasting his time with me.

‘Michael – we need
to get you out to the ambulance to do some checks, an ECG and the rest of it.
Heavy cocaine use can have an effect on your heart, especially if you mix it
with alcohol. But I’m sure you know all this.’

‘No, man. I’m
good. I just can’t breathe. Why’ve I got this pain in my chest? They said it
was a heart attack. What’s the matter with me, bro?’

‘He just needs to get some sleep,’ says Julie.
‘Come on, babe.’

‘Yeah. Sleep. I
gotta sleep. I can’t remember the last time I had a good sleep.’

‘Come on then.
Let’s take a slow walk out. But I want you to concentrate on keeping your
breathing nice and slow for us. Okay?’

We help him stand.
The pharmacy manager and his assistant are so relieved to be getting Michael
out of the store they do everything with super-brisk efficiency. The manager clicks
his fingers and gives directions; his colleagues scatter right and left to make
a passage for us through the crowds to the service lift. Michael is still
clutching his chest, grunting and groaning and dragging his feet. I feel sorry
for the shoppers who watch as we go. They stand appalled, clutching their
selections from the Two for One promotions in skin care, suddenly face to face
with Michael the crack head, sweating horribly, his prominent teeth glistening,
rolling his head from side to side and casting silvery-eyed stares around him. He
snarls at a woman.

Thursday, January 03, 2013

Elsie is quite
matter of fact about it. She may as well be talking about a touch of damp.

‘There’s a ghost?
What ghost?’

I look around.

If there’s one
house that should be haunted it’s Elsie’s. An ancient flint-walled cottage squashed
shoulder to shoulder with its neighbours these past three hundred years. The
builder must have been cross-eyed and in a rush, though, because there’s only
one square dimension in the place I can see, and that’s the TV Elsie has put in
the corner of the lounge.

Even the name on
the ceramic plaque outside has a shiver about it: Rose Cottage - the euphemism
hospitals often use for the mortuary.

‘Yes. A little
girl died in a fire here in the eighteenth century. I met a local expert who
knows about these things. He told me this is the most haunted cottage in the
village.’

‘Doesn’t that
worry you?’

‘At first I
thought: hmm. But then I thought: Well why not? What can they do? They’re only
ghosts!’

‘Yeah, but it’s
not like having mice, is it?’

‘Oh no, I think
it’s much better. So long as you don’t make a fuss and just get on with your
life, you can rub along together quite satisfactorily. You keep out of each
other’s way.’

Elsie has her bag
packed and ready. She takes one last look around.

‘She was here
just a moment ago.’

‘The little ghost?’

‘I was in the
bathroom having my shower. It gets quite steamy in there, you know. That whirly
thing is a dead loss – all noise and no action. Anyway, I’d got out of the
shower and was towelling myself down, when I saw these two tiny little hand
prints appear, in the top right hand corner of the bathroom mirror. A darling
little child’s hands.’

‘That’s pretty
spooky,’ I say. ‘That’s like something out of a film. You know – the steamy
bathroom mirror thing.’

‘Oh, she was just
messing about. Although I’ve no idea how she got up there. I’d have to stand on
a stool to reach.’

Tuesday, January 01, 2013

I race across town faster than I’ve ever
driven before, the back of the car kicking out as I accelerate hard down a
clear stretch. The address on the screen for this cardiac arrest – surely it’s
Frank’s house? I want to call Control to check, but I figure it’s best if I
concentrate on the road and get there as quickly as I can. Another ambulance
car appears behind me from a junction and tucks in behind. We drive in mad
convoy out of town to the outskirts where Frank lives, falling onto the cars
ahead of us like ravening blue devils, scattering everything left and right. We
make the street and pull up outside his house. I’m dragging bags out of the boot
when Malcolm says:

‘It’s his neighbour.’

There’s a porch light on and the door
stands open. I leave a couple of bags for Malcolm to carry and we both hurry
down the path towards it.

There’s a woman standing in the lobby,
hanging on to the bottom post of the stairs. She’s so upset she can’t talk. Instead
she points with her free hand, then gives a guttering sob and collapses on to
the bottom step. We squeeze past her and hurry up to the bedroom.

It’s a dreadful scene. Frank is there,
standing with his bare arms covered in blood, astride a woman on the floor who has
suffered a catastrophic haemorrhage. Her face is a mask of blood, clots where
her eyes should be, bloody matter extruding from her nose, a stream of blood
running out of the side of her mouth, the tip of her tongue clamped outside of
her blue lips. The double bed is liberally splattered, a pool of blood gathered
in the central depression, something like finely chopped liver scattered across
the bottom sheet, and a sodden trail of blood to the edge where the poor woman
was dragged and dumped on the floor.

‘Close the door,’ says Frank, holding his
bloodied hands and arms out to the side, touching his nose with the one clear
space available to him on the back of his right hand. ‘It’s non-viable,’ he
says. ‘Jesus Christ – what a mess.’

The woman is his neighbour. She was
diagnosed with lung cancer about a year ago, metastases in the brain and bones.
Palliative care, a DNAR in place.

‘Helen came round and got me. Apparently
Jean started coughing an hour or so after she’d gone to bed...’ He pauses and
we all take in the scene, imagining the horror of that.

‘Arrested soon after. Helen got her on the
floor – God knows how – then came to fetch me. I didn’t know about the DNAR to
begin with, so I tried a few compressions, but it was never going to work. I
may as well have been working a pump handle. Poor thing. I think Helen knew it
was hopeless from the start.’

We find some clear space to put our bags
down.

‘Let’s do what we can to tidy things up.
Then we can put her back to bed and it won’t be so hard on the family.’

We spend the next half an hour making Jean
look more presentable. I use some clinical wipes to clear as much of the blood
from her face and hair as I can. I talk to her as I do it – as much for my own
benefit as hers.

‘There we go...’ (gently easing her tongue
back into her mouth)

‘Sorry, Jean....’ (using the corner of a
wipe to hook away the congealed blood from her eyes).

‘Let’s just get this... there...’ (rubbing
her hair clear of blood, drying it off with a towel).

But Jean’s lungs are so corrupted, the
slightest tilt of her head is enough to tip a fresh stream of blood down the
side of her face. There’s nothing to be done about that, though. Our only hope
is that when she’s lying on her back on the bed, she won’t be moved for a while.

Whilst I finish cleaning Jean up, Malcolm strips
the bed, folding up all the spoiled bed linen and putting it in a discrete pile
over by the window. He finds a couple of inco pads and we use them to wipe the
parquet floor clean. Anything that’s tainted with blood we roll up and put aside
with the linen.

There’s a cowbell near the headboard.

‘That was what she used to ring when she
needed anything,’ says Frank, turning over the pillows to hide the stains. ‘It
was their little joke. It’s such a shame it ended like this.’

When I put it aside I’m careful to hold the
clapper so it doesn’t accidentally ring again.

We lift Jean up and settle her back on the
bed. I clean her face one last time to catch any new spillages. We arrange her
arms by her sides, and then drape one of our own blankets over her.

Frank goes downstairs to comfort Helen
whilst I finish the paperwork. Malcolm calls the family undertakers and
arranges for collection. We take one last look around, and then carry our bags
back down.

Frank is standing in the hallway with
Helen.

‘Thanks for all you’ve done,’ she says.

I tell her I’m sorry for her loss – the usual
awkwardness – then leave.

Outside, the night has deepened. It comes rushing
towards us across miles of open field with a tail of pin bright stars. It’s exhilarating,
standing here outside the house like this. Dizzying, like we’re feeling the way
the world moves for the first time, the spin, the implacable momentum of
it all.

I stow the bags back in the car. We chat a
little, make a few cracks, talk about this and that, head back to base.